Recent advances in ctDNA detection using electrochemical biosensor for cancer.

In the quest for early cancer diagnosis, early identification and treatment are paramount. Recently, ctDNA detection has emerged as a viable avenue for early screening of cancer. The examination of ctDNA in fluid biopsies has gained substantial attention in tumor diagnosis and therapy. Both the scientific community and industry are actively exploring this field. However, developing cost-effective, portable, and real-time ctDNA measurement methods using conventional gene detection equipment poses a significant challenge. This challenge has led to the exploration of alternative approaches. Electrochemical biosensors, distinguished by their heightened sensitivity, remarkable specificity, affordability, and excellent portability, have emerged as a promising avenue for ctDNA detection. This review is dedicated to the specific focus on ctDNA detection, highlighting recent advancements in this evolving detection technology. We aimed to reference previous studies related to ctDNA-targeted cancer detection using electrochemical biosensors to advocate the utilization of electrochemical biosensors in healthcare diagnostics. Further research is imperative for the effective integration of ctDNA analysis into point-of-care cancer testing. Innovative approaches utilizing multiple markers need to be explored to advance this technology and make substantial contributions to societal well-being.

Treatment Challenges and Controversies in the Management of Critically Ill Diabetic Ketoacidosis (DKA) Patients in Intensive Care Units.

This review discusses the challenges and controversies in the treatment of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Key areas include the selection of intravenous (IV) fluids, insulin therapy, strategies for preventing and monitoring cerebral edema (CE) by managing hyperglycemia overcorrection, electrolyte replacement, timing of nutrition, use of IV sodium bicarbonate, and airway management in critically ill DKA patients. Isotonic normal saline remains the standard for initial fluid resuscitation, though balanced solutions have been shown to have faster DKA resolution. Current guidelines recommend using continuous IV insulin for DKA management after fluid status has been restored potassium levels have been achieved and subcutaneous (SQ) insulin is started only after the resolution of metabolic acidosis. In comparison, the British guidelines recommend using SQ insulin glargine along with continuous regular IV insulin, which has shown faster DKA resolution and shorter hospital stays compared to continuous IV insulin alone. Although rare, rapid overcorrection of hyperglycemia with fluids and insulin can lead to CE, seizures, and death. Clinicians should be aware of risk factors and preventive strategies for CE. DKA frequently involves multiple electrolyte abnormalities, such as hypokalemia, hypophosphatemia, and hypomagnesemia and regular monitoring is essential for DKA management. Early initiation of oral nutrition has been shown to reduce intensive care unit and overall hospital length of stay. For impending respiratory failure, Bilevel positive airway pressure is not recommended due to aspiration risks. Instead, intubation and mechanical ventilation, with monitoring and management of acid-base and fluid status, are recommended. The use of sodium bicarbonate is discouraged due to the potential for worsening ketosis, hypokalemia, and risk of CE. However, IV sodium bicarbonate can be considered if the serum pH falls below 6.9, or when serum pH is less than 7.2 and/or serum bicarbonate levels are below 10 mEq/L, pre-and post-intubation, to prevent metabolic acidosis and hemodynamic collapse that occurs from apnea during intubation. Managing DKA and HHS in critically ill patients includes using balanced IV fluid solutions to restore volume status, followed by continuous IV insulin, early use of SQ glargine insulin, electrolyte replacement, and monitoring, CE preventive strategies by avoiding hyperglycemia overcorrection, early nutritional support, and appropriate airway management.

Ambipolar macrocycle derived from spiro-xanthene and carbazole: synthesis, structure-property relationships, electronic properties and host-guest investigation.

For the first time, we present the detailed synthesis, photophysical, electrochemical, host-guest and charge transport properties of spiro[fluorene-9,9'-xanthene] (SFX) and carbazole macrocycle SPS-NR-02. The electron and hole transport values measured using the space charge limited current (SCLC) method resulted in ambipolar charge transport with an electron to hole mobility ratio of 0.39.

Visible light-driven molecular oxygen activation for oxidative amidation of alcohols using lead-free metal halide perovskite.

Herein, we report the modulation of the band structures of halide perovskite Cs2CuBr4 by tuning the synthesis methods. The photocatalyst PC-1, synthesized by the hot injection method, has a more negative conduction band minima (CBM) than the photocatalyst PC-2, synthesized at room temperature. As a result, PC-1 can activate molecular O2 more efficiently to initiate the radical-mediated dehydrogenation of alcohols. The more positive valence band maxima (VBM) of PC-1 also facilitates amine oxidation to the corresponding radical. Further, improved charge separation and transport and a decrement in the photogenerated charge carrier recombination have been detected for PC-1 to enhance photocatalytic activity. PC-1 showed improved yields for a series of structurally diverse amides (highest yield = 98%) by oxidative amidation of alcohols under visible light irradiation.

Recurrent pulmonary nocardiosis due to Nocardia Otitidiscaviarum in a patient with isolated CD4 lymphocytopenia: a case report.

BACKGROUND: Idiopathic CD4 lymphocytopenia (ICL) is an underdiagnosed immunodeficiency syndrome characterised by persistent low CD4 counts in the absence of HIV and other causes of lymphocytopenia. ICL patients are susceptible to opportunistic infections, with human papillomavirus, cryptococcal, and tuberculosis being the most common infections reported. Nocardiosis is rarely reported in patient with ICL. CASE PRESENTATION: We herein discuss a 46-year-old female presented with complaints of weight loss, low grade fever and cough with expectoration from last four months. The patient was diagnosed with pulmonary nocardiosis and aspergillosis co-infection four years back; in addition she also had ICL. Subsequently, the patient was lost in follow-up and readmitted four years later. Bronchoalveolar lavage sample shows the presence of acid-fast bacilli in modified gram stain, which later identified as Nocardia otitidiscaviarum by metagenomic next-generation sequencing. Her CD4 counts were still found low (298 cells/mm3). After an initial improvement with trimethoprim-sulfamethoxazole (TMP-SMX), she was commenced on indefinite secondary prophylaxis. CONCLUSIONS: Nocardiosis without usual risk factors should be evaluated for ICL. This case emphasize the importance of periodic follow-up with CD4 count monitoring and secondary prophylaxis therapy to prevent recurrence or the emergence of new infections in ICL. CLINICAL TRIAL NUMBER: Not applicable.

'Effectiveness of various Sulbactam based Combination Antibiotic Therapy in Management of Ventilator-Associated Pneumonia caused by Carbapenem-Resistant Acinetobacter baumannii in a Tertiary Care Health Centre.'

OBJECTIVE: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a common cause of ventilator-associated pneumonia (VAP). Some in vitro data favour various combination antibiotic therapy. However, there is a need for more in vivo studies for the management of VAP caused by CRAB. This retrospective study was done to evaluate the effectiveness of various combination antibiotic therapy including sulbactam on outcomes of VAP caused by CRAB. METHODS: Adult patients (age ≥ 18 years) diagnosed with VAP caused by CRAB were included. Patients with polymicrobial infections were excluded from the study. Patients with CRAB associated VAP who were given sulbactam based antibiotic combinations were observed for outcomes. The primary outcome was 28-day mortality after diagnosis of VAP caused by CRAB. Reduction in serum HsCRP (High sensitivity C-reactive protein) during treatment and requirement of inotropes were the secondary outcomes. Outcomes were compared between various sulbactam based antibiotic combination therapies. RESULTS: A total of 103 patients were included. A total of 44 (42.7%) patients received sulbactam and minocycline or sulbactam and polymyxin B dual antibiotic combination, and 59 (57.3%) patients received sulbactam, polymyxin B and minocycline triple antibiotic combination. The percentage difference in 28 days mortality was 27.51% (95% CI 8.03% to 44.06%; p=0.005) in dual vs triple sulbactam based antibiotic combination therapy. The percentage difference in requirement of inotropes during therapy and HsCRP reduction after 7 days of therapy was 23.65% (95% CI 6.43% to 38.3%; p=0.007) and 25.1% (95%CI 10.1% to 38.2%; p<0.001) respectively when compared between dual vs triple sulbactam based antibiotic combination therapy. CONCLUSION: Treatment with sulbactam, polymyxin B and minocycline combination antibiotic therapy was associated with significantly lower 28-day mortality. Moreover, the lower requirement of inotropes during treatment and a significant reduction in HsCRP level favours this combination antibiotic therapy in VAP caused by CRAB.

Pattern of Answer Script Presentation Errors: Teacher and Student Perspectives.

Background Answer script presentation is an effective means of conveying knowledge and understanding. It reflects clarity of thought and organization, which can positively influence scoring. Additionally, well-structured answers reduce the chances of misinterpretation, ensuring that your knowledge is accurately assessed. Despite its importance, there is limited research focusing on the specific errors students make in presenting their answers. Hence, this study explored common errors in answer script presentation from the perspectives of both teachers and students. Methods A cross-sectional study was conducted involving 240 students and 50 teachers in July 2024 at Mata Gujri Memorial Medical College, Bihar, India. A questionnaire was developed by a three-member panel of experts in education and assessment to ensure it was comprehensive and relevant to the study's objectives. The questionnaire comprised 12 items rated on a 5-point Likert scale where a higher score indicates higher perceptions of the error. Data were collected from teachers and students using the pre-tested self-administered printed questionnaire. The scores among the different perceived errors were compared by ANOVA and the scores between teachers and students were compared by unpaired t-test. Results Students perceived that their highest error was inconsistent handwriting (2.72±1.4), followed by incomplete diagrams (2.52±1.2) and disorganization (2.47±1.17). The error perceived to be least important was incorrect numbering (1.53±0.97), F=12.49, p-value<0.0001. Teachers perceived the error in illegible handwriting (4.36±0.48), followed by lack of emphasis (4.16±0.62) and disorganization (3.94±0.91) as the errors most likely to contribute to poor performance. The error perceived to be least important was inconsistent handwriting (2.4±1.01), F=18.22, p-value<0.0001. When the data were compared between teachers and students, except for inconsistent handwriting, the perceived error score by teachers was higher than the students perceived. Conclusion There was a significant disparity between students' and teachers' perceptions of common presentation errors, with teachers consistently rating the severity of errors higher than students. Both groups identified inconsistent handwriting as a prominent error. This underscores the need for better alignment and communication between students and educators regarding the importance of specific aspects of written presentation in assessments.

Exploring the uncharted seas: Metabolite profiling unleashes the anticancer properties of Oscillatoria salina.

Marine cyanobacteria offer a rich source of varied natural products with both chemical and biological diversity. Oscillatoria salina (O. salina) is a filamentous non-heterocystous marine cyanobacterium from Oscillatoriaceae family. In this investigation, we have unveiled bioactive extracts from O. salina using two distinct solvent systems, revealing significant anticancer properties. Our assessment of the organic and aqueous extracts (MCE and AE) of O. salina demonstrated pronounced antiproliferative and antimetastatic effects. Notably, this study is the first to elucidate the anticancer and anti-metastatic potential of O. salina extracts in both 2D and 3D cell culture models. Both MCE and AE induced apoptosis, hindered cell proliferation, invasion, and migration in A549 non-small cell lung cancer cells, accompanied by alterations in cell morphology and cytoskeleton collapse. Moreover, MCE and AE induced spheroid disintegration in A549 cells. Transcriptomics analysis highlighted the significant involvement of Rap1 and p53 signaling pathways in mediating the observed antitumor effects. Mass spectroscopy characterization of these extracts identified 11 compounds, some known for their anticancer potential. HPLC analysis of AE revealed six peaks with UV absorption spectra resembling phycocyanin, a cyanobacterial pigment with well-known anticancer activity. Collectively, these findings underscore the anticancer potential of MCE and AE, containing bioactive metabolites with anticancer and antimetastatic properties.

Air Gun Pellet Injury to Internal Carotid Artery: A Case Report and Review of Literature.

Airgun injuries are prevalent in the pediatric population. The present study described a case of air gun pellet injury to the left carotid artery and its successful management. A 25-year-old man presented to the emergency department complaining that his son had accidentally injured him with an air gun pellet while playing. The X-ray cervical spine revealed a single foreign body (pellet) located directly anterior to the C5-C6 vertebra. A CT angiography of the neck showed a spherical hyperdense object just anterior to the C6 vertebral body on the left side, 3 mm posteromedial to the left common carotid artery, which was most likely a pellet foreign body. The patient was sent to operation theatre (OT) for exploration. There was a rent in the internal carotid artery with active bleeding. After exerting both proximal and distal control, the rent was closed. Close air gun injury could result in gunshot wounds, as in the present case. Plain X-rays in AP and lateral view are required. Nonoperative management could be employed in a restricted group of patients with satisfactory outcomes. Those who have vascular involvement will require surgical intervention.

A unique approach to address avoided crossings in the charge stabilization curve for LUMO identification.

In quantum chemistry, Lowest Unoccupied Molecular Orbital (LUMO) is important for studying various chemical processes, including photochemical reactions, electron attached states, and electron excites states. Recently, an effective method has been introduced that involves the use of the Parametric Equation of Motion (PEM) in conjunction with the nuclear charge stabilization method for precise identification of true LUMO. However, the inclusion of extra diffuse functions in the basis set, which is necessary for describing electron-attached and electron-excited states, can cause issues due to the presence of the same symmetry states, leading to avoided crossing. Identifying the true LUMO among these avoided crossings is challenging due to the mixing of states and the exchange of their orbital character. This article introduces a modification of the PEM to identify the true LUMO by preventing the stabilization of specific states involved in avoided crossings. The present method is highly effective and requires minimal computational cost.